Evaluation of Neurocognition in Youth with CKD Using a Novel Computerized Neurocognitive Battery

Hartung, Erum A.; Kim, Ji Young; Laney, Nina; Hooper, Stephen R.; Radcliffe, Jerilynn; Port, Allison M.; Gur, Ruben C.; Furth, Susan L.

doi:10.2215/cjn.02110215

Cited by 32 publications

(22 citation statements)

References 35 publications

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“…Some have found no significant differences in memory (verbal and nonverbal) between children with and without CKD (11). Others have reported specific deficits in complex auditory attention, verbal working memory, and the recognition of emotional states (11,12). The extent and patterns of neurocognitive and academic impairment in children may also vary by CKD stage.…”

Section: Introductionmentioning

confidence: 99%

Neurocognitive and Educational Outcomes in Children and Adolescents with CKD

Chen¹,

Didsbury²,

Zwieten³

et al. 2018

CJASN

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Background and objectives Poor cognition can affect educational attainment, but the extent of neurocognitive impairment in children with CKD is not well understood. This systematic review assessed global and domainspecific cognition and academic skills in children with CKD and whether these outcomes varied with CKD stage.Design, setting, participants, & measurements Electronic databases were searched for observational studies of children with CKD ages 21 years old or younger that assessed neurocognitive or educational outcomes. Risk of bias was assessed using a modified Newcastle-Ottawa scale. We used random effects models and expressed the estimates as mean differences with 95% confidence intervals stratified by CKD stage.Results Thirty-four studies (25 cross-sectional, n=2095; nine cohort, n=991) were included. The overall risk of bias was high because of selection and measurement biases. The global cognition (full-scale intelligence quotient) of children with CKD was classified as low average. Compared with the general population, the mean differences (95% confidence intervals) in full-scale intelligence quotient were 210.5 (95% confidence interval, 213.2 to 27.72; all CKD stages, n=758), 29.39 (95% confidence interval, 212.6 to 26.18; mild to moderate stage CKD, n=582), 216.2 (95% confidence interval, 233.2 to 0.86; dialysis, n=23), and 211.2 (95% confidence interval, 217.8 to 24.50; transplant, n=153). Direct comparisons showed that children with mild to moderate stage CKD and kidney transplants scored 11.2 (95% confidence interval, 2.98 to 19.4) and 10.1 (95% confidence interval, 21.81 to 22.0) fullscale intelligence quotient points higher than children on dialysis. Children with CKD also had lower scores than the general population in executive function and memory (verbal and visual) domains. Compared with children without CKD, the mean differences in academic skills (n=518) ranged from 215.7 to 21.22 for mathematics, from 29.04 to 20.17 for reading, and from 214.2 to 2.53 for spelling.Conclusions Children with CKD may have low-average cognition compared with the general population, with mild deficits observed across academic skills, executive function, and visual and verbal memory. Limited evidence suggests that children on dialysis may be at greatest risk compared with children with mild to moderate stage CKD and transplant recipients.

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Section: Introductionmentioning

confidence: 99%

Neurocognitive and Educational Outcomes in Children and Adolescents with CKD

Chen¹,

Didsbury²,

Zwieten³

et al. 2018

CJASN

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“…However, the association between cognitive impairment and CKD persists (7)(8)(9), even after adjusting for cerebrovascular diseases (1)(2)(3). Moreover, cognitive impairment has been observed in children with CKD, the large majority of whom do not have cerebrovascular disease (10). Most importantly, several studies showed that cognitive function improved and sometimes almost normalized after kidney transplantation (11)(12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

Cognitive Function and Uremic Toxins after Kidney Transplantation: An Exploratory Study

Linde¹,

Roij

Meijers

et al. 2020

Kidney360

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Background: Cognitive functions are altered in patients with chronic kidney disease. However it is suggested that cognitive functions, at least partially, improve after kidney transplantation. A possible cause for this improvement could be the reduction of uremic retention solutes after transplantation. This study assessed the association between the changes in uremic toxin concentration with the changes in cognitive function in patients after kidney transplantation. Methods: 10 kidney transplant recipients were included and compared to 18 controls (9 patients on hemodialysis, and 9 patients with CKD stage 4 or 5 (eGFR < 30ml/min/1.73m 2 not on dialysis). An extensive neuropsychological assessment, covering the five major cognitive domains, that is, memory, attention and concentration, information processing speed, abstract reasoning, and executive function, was done before, at one week and three months after transplantation. Similarly assessments of the 18 matched control patients were performed longitudinally over a period of three to five months. Concentrations of sixteen uremic retention solutes namely indoxylglucuronide, pcresylglucuronide, phenylglucuronide, CMPF, indoxyl sulphate, p-cresyl sulphate, hippuric acid, phenyl sulphate, kynurenine, tryptophan, kynurenic acid, tyrosine, indole-3-acetic acid, phenylalanine, trimethylamine N-oxide (TMAO), and phenylacetylglutamine were measured in serum samples collected at the time of the neuropsychological assessments. Results: A significant improvement in cognitive function was only found in the processing speed domain, and observed in both transplant patients as well as CKD patients. No significant differences between transplant patients and the control groups were seen in the other cognitive domains. As expected, the serum concentration of most uremic toxins decreased significantly within one week after kidney transplantation. Conclusions: There was no significant improvement in cognitive function that could be specifically related to kidney transplantation in the first 3 months after the procedure. These data do not support the notion that uremic toxins exert an immediate effect on cognitive function.

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“…Research into the neuropsychological profile of children post‐kidney transplantation shows lower performance on complex auditory attention and visual working memory tasks . Performance on continuous performance tasks used to directly assess attention and inhibitory control has been found to be significantly impaired among youth with chronic kidney disease . Longer duration of chronic kidney disease is associated with increased risk of poor performance on this measure of attention .…”

Section: Introductionmentioning

confidence: 99%

“…8 Performance on continuous performance tasks used to directly assess attention and inhibitory control has been found to be significantly impaired among youth with chronic kidney disease. 18,19 Longer duration of chronic kidney disease is associated with increased risk of poor performance on this measure of attention. 20 Parents of children with chronic kidney disease rate their children as having more difficulties with working memory, planning, and organizing skills than do parents of children without chronic kidney disease.…”

Section: Introductionmentioning

confidence: 99%

Educational needs in families of pediatric liver and kidney transplant recipients: A quality improvement project

daCruz

Cousino

Smith

et al. 2019

Pediatric Transplantation

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Parents of pediatric liver and kidney transplant recipients were surveyed regarding their current education plans (eg, Individualized Education Program, 504), satisfaction with these plans, and interest in educational support from the psychosocial transplant team. Survey results indicate high rates of IEP and 504 plans, academic and related services, and accommodations among this population. The majority of parents/guardians reported satisfaction with their child's current school plan and did not report need for additional transplant team support specific to school services on the survey measure. However, other information highlights the importance for pediatric transplant teams to consider other ways to support this population's educational needs.

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Evaluation of Neurocognition in Youth with CKD Using a Novel Computerized Neurocognitive Battery

Cited by 32 publications

References 35 publications

Neurocognitive and Educational Outcomes in Children and Adolescents with CKD

Neurocognitive and Educational Outcomes in Children and Adolescents with CKD

Cognitive Function and Uremic Toxins after Kidney Transplantation: An Exploratory Study

Educational needs in families of pediatric liver and kidney transplant recipients: A quality improvement project

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